Provider Demographics
NPI:1972206506
Name:SAMPLES, ZACHARY AUSTIN
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:AUSTIN
Last Name:SAMPLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 REINHARDT COLLEGE PKWY STE 9
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5298
Mailing Address - Country:US
Mailing Address - Phone:706-973-7504
Mailing Address - Fax:
Practice Address - Street 1:149 REINHARDT COLLEGE PKWY STE 9
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5298
Practice Address - Country:US
Practice Address - Phone:678-483-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHAA000211237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist